MEDICARE: MR. ROBERT N WIANT PCCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	E002896/SUPV	OH

General Provider Information

NPI Number	:	1154394245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT N WIANT PCCS

Provider Business Mailing Address
First Line	:	1791 ALUM CREEK DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43207-1708
Country	:	US
Telephone Number	:	614-443-8131
Fax Number	:

Provider Business Practice Location Address
First Line	:	715 S PLUM ST
Second Line	:
City	:	MARYSVILLE
State	:	OH
Zip	:	43040-1631
Country	:	US
Telephone Number	:	937-644-9192
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	12/02/2016

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